Care Manager - UnityPoint Health : Job Details

Performs utilization and case management reviews using established criteria to confirm medical necessity, appropriate level of care and efficient use of resources and payment approval. Requests reviews with physician advisors, and/or Executive Health Resources (EHR), as appropriate, if admission or continued stay criteria are not met, assuring appropriate and timely level of care status. Conducts payment authorizations and coordinated payment denials while meeting timeliness guidelines. Ensures case coordination with client's health care providers. Provides utilization management and case management to designated enrollees. Assuring that all enrollees receive clinically sound triage/referral and ongoing care management services for medical needs. Qualifications. Education:Registered Nurse. CCM (Certified Case Manager) Experience:5 years of nursing experience. Insurance experience on the company side is required. License(s)/ Certification(s):Compact Nursing License / or licensed...Care Manager, Manager, Behavioral Health, Healthcare, Management